Stronger eye care systems in Aboriginal primary health care

National Rural Health Conference - 27 May 2015

Anna Morse1,2, Colina Waddell1,2, Jenny Hunt3, Fiona MacFarlane4, Daniel Jackman5, Christine Corby6, Tricia Keys1,2

1 Brien Holden Vision Institute 2 Vision Cooperative Research Centre 3 Aboriginal Health & Medical Research Council 4 Wurli-Wurlinjang Health Service 5 Coonamble Aboriginal Health Service 6 Walgett Aboriginal Medical Service

A team effort

Vision CRC Partners

Implementing Partners

Coonamble Aboriginal Health Service

KATHERINE WEST HEALTH BOARD

Presentation Outline

Why focus on Primary Health Care for eye care outcomes?

How was this done?

What happened?

So what does this mean?

WHY Primary Health Care?

► Vision loss for Aboriginal & Torres Strait Islander people is:1

more common

largely avoidable

1. Taylor HR, Keeffe JE, Arnold AL, Dunn RA, Fox SS, Goujon N, et al. National Indigenous Eye Health Survey, Minum Barreng (Tracking Eyes). Melbourne, Australia: Indigenous Eye Health Unit, Melbourne School of Population Health, The University of Melbourne, 2009.

WHY Primary Health Care?

► Vision loss for Aboriginal & Torres Strait Islander people is:1

more common (blindness 6x, low vision 3x)

largely avoidable

1. Taylor HR, Keeffe JE, Arnold AL, Dunn RA, Fox SS, Goujon N, et al. National Indigenous Eye Health Survey, Minum Barreng (Tracking Eyes). Melbourne, Australia: Indigenous Eye Health Unit, Melbourne School of Population Health, The University of Melbourne, 2009.

WHY Primary Health Care?

► Vision loss for Aboriginal & Torres Strait Islander people is:1

more common (blindness 6x, low vision 3x)

largely avoidable (94%)

1. Taylor HR, Keeffe JE, Arnold AL, Dunn RA, Fox SS, Goujon N, et al. National Indigenous Eye Health Survey, Minum Barreng (Tracking Eyes). Melbourne, Australia: Indigenous Eye Health Unit, Melbourne School of Population Health, The University of Melbourne, 2009.

WHY Primary Health Care?

► Early detection, timely referral, follow-up better outcomes.

► Diabetes eye care: part of annual cycle, preventative.

► Primary Health Care (PHC) forms the “front line”

WHY Primary Health Care?

►Referral pathways: effective and efficient

WHY Primary Health Care?

►Referral pathways: effective and efficient

WHY Primary Health Care?

►PHC as the foundation for eye care:

broadly acknowledged, but

WHY Primary Health Care?

►PHC as the foundation for eye care:

broadly acknowledged, but

need practical tools to guide it

HOW was it done?

►PAR (Participatory Action Research).

Aboriginal Community Controlled Health Services (ACCHS): NSW & NT

“Models of vision care delivery in Aboriginal and Torres Strait Islander communities”

HOW was it done?

HOW was it done?

►Ongoing, iterative process, asking:

What?

Why?

How?

HOW was it done?

►What? Map services, identify gaps.

Regional eye care systems assessment

►Why? Understand ACCHS priorities - focus groups

Review guidelines and evidence base

►How? Process guided by ACCHS, working together

HOW was it done?

►Framework for the whole process: Building on strengths, Incremental improvement (bit by bit)

►CQI elements included: File audits & data, CQI cycles Service mapping Action at local, organisational and regional levels Systems assessment, patient experience components

Local (clinic) Goal-setting

HOW was it done?

►Systems assessment►Patient experience

►Collaborative approach: range of perspectives

Combined data &

approaches

Gaps &needs

determined

Priorities for

collective action set

Local Organisation

Regional State / National

HOW was it done?

►Guided by focus groups & clinical guidelines►Mix of training activities: 3 x on-site sessions, online module, resources

HOW was it done?

►Highly interactive, linked with CQI process

HOW was it done?

HOW was it done?

www.rahc.com.au/elearning

HOW was it done?

►Supporting systems and processes, including: PHC systems Regional systems Coordination

WHAT happened? CQI Data

► Optometry: improvements for all components access referrals refractive

correction

WHAT happened? CQI Data

► Smaller impact for primary care checks other variables Adult Health Check only

► Annual diabetes retinal exams: notable increase Consider national

average (~25%)

WHAT happened? CQI Data

► Increased numbers and completion of specialist eye care pathways: Cataract Diabetes eye care

WHAT happened? Training

WHAT happened? Eye care system

WHAT happened? Outputs

Eye & Vision Care “TOOLKIT”

Integrated, useful and practical set of tools and approaches for supporting eye care systems:

► CQI tools

► Education packages

► Regional planning tools

► Understanding community

SO WHAT does this mean?

►Positive changes after 2 years

►Important these processes are:

translatable simple, practical methods replicable “real life” research

SO WHAT does this mean?

►Foundational role of Primary Health Care eye care improvements evidence to build on other specialty areas

SO WHAT does this mean?

Strategies for the Prevention of Blindness in National Progammes: A Primary Health Care Approach (1997)

“Primary eye care as a part of comprehensive primary health care”

“primary health care approach to prevention of blindness”

“the provision of eye care as an integral part of primary health care as a key strategy”

POLICY recommendation

Building primary health care capacity is an effective strategy for improving eye care for Aboriginal and Torres Strait Islander people.

Therefore, supporting eye care in the Aboriginal and Torres Strait Islander primary health care setting across Australia is important.